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目的 本研究拟对不同心脏病所致的心力衰竭 (CHF)患者 ,检测心脏 β1和M2 受体的自身抗体 ,探讨心功能发生病理变化时 ,这两种自身抗体的产生与疾病发生、发展的相关性。方法 以细胞外第二环表位肽段的合成肽作为抗原 ,应用酶联免疫吸附测定 (ELISA)技术 ,随机检测 2 6 5例受试者血清中心脏 β1和M2 受体的自身抗体。 188例为不同心脏病CHF患者 ,其中缺血性心肌病 (ICD) 4 2例、扩张型心肌病 (IDCM) 5 2例、高血压性心脏病 (HHD) 4 4例、风湿性心脏病 5 0例 ;单纯高血压 (HP) 36例及正常人 (NC) 4 1例为对照组。结果 CHF组 β1受体自身抗体的阳性率为 4 5 7% (86 / 188) ,明显高于HP组和NC组的 10 4 % (8/ 77) (P <0 0 1) ;CHF组M2 受体自身抗体的阳性率为 4 9 5 % (93/ 188) ,明显高于HP组和NC组的 11 7% (9/ 77) (P <0 0 1) ;心功能Ⅱ Ⅲ级的阳性率及抗体滴度明显高于Ⅳ级 ;CHF组β1受体自身抗体阳性血清中高达 5 6 1%的患者同时具有M2 受体的自身抗体。结论 心脏β1和M2 受体自身抗体存在于多种心脏病心力衰竭患者的血清中 ,可能与心力衰竭时心肌结构变化和功能下降有关 ,与原发心脏病无明显因果关系 ;β1和M2 受体的双抗体阳性可能是自身免疫反应的多重性表现 ,提示免疫学机制参与心力衰竭?
OBJECTIVE: This study aimed to detect the autoantibodies of cardiac β1 and M2 receptors in patients with heart failure (CHF) caused by different heart diseases and to explore the pathogenesis and development of these two autoantibodies in the pathological changes of cardiac function Correlation. Methods The synthetic peptides of extracellular loop epitope peptides were used as antigen. Serum β1 and M2 receptor autoantibodies were detected by enzyme - linked immunosorbent assay (ELISA). 188 cases of CHF patients with different heart disease, including ischemic cardiomyopathy (ICD) in 42 cases, dilated cardiomyopathy (IDCM) 52 cases, hypertensive heart disease (HHD) 44 cases, rheumatic heart disease 5 0 cases; 36 cases of simple hypertension (HP) and 41 cases of normal people (NC) as the control group. Results The positive rate of β1 receptor autoantibodies in CHF group was 45.7% (86/188), which was significantly higher than that in HP group and NC group (10/4) (8/77) (P <0.01) The positive rate of autoantibody was 495% (93/188), which was significantly higher than that in HP group and NC group (11 7%, 9/77) (P 0 01) The antibody titer and antibody titer were significantly higher than those of grade Ⅳ. As high as 561% of CHF patients with β1 receptor autoantibodies also had autoantibody of M2 receptor. Conclusions The autoantibodies to cardiac β1 and M2 receptors exist in the serum of patients with heart failure due to various heart diseases, which may be related to the changes of cardiac structure and function decline in heart failure. There is no obvious causal relationship between the β1 and M2 receptors autoantibodies and primary heart disease. The double antibody positive may be multiple manifestations of autoimmune reactions, suggesting that immunological mechanisms involved in heart failure?